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Deb,

Did you duplex the legs? Were the femoral wave forms diminished too?  Inflow
disease could change the waveforms.  Did you look at the aorta and iliac
arteries?   The pressures may be falsely elevated due to calcification in
the vessel walls or from the edema preventing good cuff placement.  I think
a duplex is the way to go in a case like this.  It is always nice to see the
artery when you can't get complete data from the indirect tests.  It sounds
like the edema is unrelated to his arterial symptoms and may be due to his
chronic venous problems.  I hope my two cents helped.

Good Luck,

Joe Lopez


-----Original Message-----
From: Don Thompson <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: Tuesday, September 07, 1999 8:08 PM
Subject: arterial vs venous


>I had a very interesting study today and would like to pick all you
>brains for your opinions.
>I had a 78 year old man in for lower arterial testing. He had past
>history of DVT left pop-post tib found first in May and re-imaged in
>July with some recanalization noted.
>Has been on home therapy for DVT.  His nephrologist ordered segmental
>pressures with doppler to I guess rule out occuded vessels.  His left
>leg had 2-3+ edema was red from foot to mid shin.  But also his left leg
>was very cool to touch from mid shin down, warm from there up.  He
>stated he had no real pain or tenderness.
>Testing findings were normal right leg except that up thigh and calf
>cuff could not be totally occluded.  Left extremity thigh had all
>pressure within normal limits also, but wave forms were diminished, and
>even had toe pressures noted.  Left ankle could not be totally occluded
>either.  Otherwise the  study would be considered normal by  most
>standards, except for the fact the leg was swollen, cool, and red.
>Consulted senior retired vascular surgeon and he agreed with the fast
>that the DVT should be evaluated again...The coolness of the leg was our
>biggest discussion....
>I am ready for all your opinions....and very interested in them too.
>
>thanks,
>deb thompson, cvtech, HVCH